Sunday, March 25, 2012

Health Care Debate: A Tale Of Two Societies

On Monday the Supreme Court will begin listening to three days of oral arguments regarding the constitutionality of the President’s signature piece of legislation: the Patient Protection and Affordable Health Care Act…better known as “Obamacare”.  The court’s ruling will be one of the most important in our lifetime and will serve as a key component in defining who we are as a society.
If you find our assertions too melodramatic for your liking then consider these facts:
Forty two million US citizens are currently without health care.  The cost of health care represents one sixth of the US economy.  Health care expenditures in the United States rose to $2.6 trillion in 2010, over ten times the $256 billion spent in 1980.  Since 2001, employer-sponsored health care coverage for family premiums has increased by 120%.  The average American spends 18 cents of every dollar earned on health care.  The United States spends more per capita on health care than any other industrialized nation; 50% more than the next highest country and two and a half times more than the average of all the other industrialized countries combined. 
In spite of spending more on health care than any other country we get far less bang for our buck.  We have fewer doctors per capita than most of the other industrialized countries.  Our life expectancy is lower than most other industrialized countries.  Our infant mortality is higher.  And our obesity rates are the highest; which leads to higher health care expenditures in the future.  Our economy is on the verge of collapsing under the weight of skyrocketing health care costs while at the same time our overall quality of life is deteriorating.
The Patient Protection and Affordable Health Care Act is a massive, unwieldy attempt to lower health care costs, provide preventative health care to all Americans, and provide basic coverage to 30 million currently uninsured individuals; thereby improving our overall quality of life while reducing the strain on our economy. And it is attempting to do these things within the framework of the current free market delivery system…a difficult if not impossible task.
There are some good components of the bill that people generally like.  Young adults can now stay on their parent’s policy until the age of 26; a major benefit during this time of high employment.  Insurers are now required to cover individuals who have pre-existing conditions.  Insurers are no longer allowed to terminate an individual’s coverage due to a pre-existing condition.  People can no longer be turned down for health insurance if they switch jobs, and their coverage will stay in force if they lose their job.  Millions are getting preventative care that now must be provided at no additional cost to patients. The list goes on and on.  Most of the individual components of the act will go into effect over the next decade.
But in spite of all the attributes of this legislation the Republicans want to repeal the law in its entirety.  Their major beef is a 2014 requirement that mandates that all individuals purchase some form of health insurance or pay a fine.  Republicans argue that this provision is unconstitutional and a threat to our liberty.  They see this requirement as just another example of big government over reach by the Obama administration.  For this the law must be repealed.
Unfortunately the Republicans have no alternative plan.  When pressed they say we need to allow insurance companies to market across state lines; which will increase competition, lower rates and improve affordability and availability.  Let the free market prevail!  The problem with that theory is that insurance companies can already market across state lines.  All they have to do is agree to follow the state regulations in those states in which the wish to do business.  Many insurance providers will not enter certain states due to the fact that they have very restrictive requirements, including limits on the premiums companies may charge.  So unless the Republicans are going to order states to set aside their individual state regulations in favor of “mandated” federal policies…an act that would be the very government over reach Republicans abhor…their free market solution is nothing more than the status quo.  And just to be clear, the status quo is what got us in this mess in the first place. 
Furthermore, the status quo cannot reduce the cost of health coverage as long as it allows roughly 40 million uninsured people access to health services without asking them to pay anything for the service.  Somebody has to pay for it; hence the mandate.  The only way that the existing distribution system works is if you either force everyone to buy in or refuse health services to those who can’t afford coverage or choose to do without.  In essence to leave them dying in the streets.
Too harsh?  Ron Paul said as much in a recent debate.  He said "back in the day the churches took care of the uninsured."  When pressed as to what would happen to them if random “church provided” health services were not available, Paul said: “We all make choices in our lives.”
 And as to the constitutionality of mandating the purchase of insurance; how do we declare this mandate to buy coverage unconstitutional when many among us wish to mandate the prohibition of contraceptives and the implementation of trans-vaginal ultrasounds prior to undergoing a legal health care procedure?  Are these mandates any less intrusive?  Arguing that one is a federal requirement while the others are state sponsored is splitting hairs.
So that is why this Supreme Court ruling is so important.  Do we find a way to take care of our own, reduce our costs and improve our health care system?  Or do we return to the status quo and leave the neediest among us to suffer while we spend $2 billion a week building hospitals and providing health care to people in Iraq and Afghanistan?   
There is no doubt that “Obamacare” in its current form needs some work.  The law needs to be more aggressive and effective in cutting costs and more transparent in its funding  But repealing the law and returning to the status quo will not only fail to fix the problem it will leave millions of Americans in a hopeless situation.
So we ask the question…what kind of society we want to be.



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